AB0698 SYSTEMIC LUPUS ERYTHEMATOSUS OVER 80 YEARS OF AGE: A RETROSPECTIVE COHORT OF VERY LATE-ONSET IN A THIRD LEVEL HOSPITAL
Authors: A. Crespo-Golmar, C. Moriano, X. E. Larco Rojas, C. Sieiro Santos, P. Pérez-García, E. Diez Álvarez
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Late-onset systemic lupus erythematosus (SLE) is designated as that developing after the age of 50 [1], [2]. It has been associated with a different prevalence of clinical manifestations, disease activity, and mortality compared to early-onset SLE. <h3>Objectives</h3> - To describe the clinical expression and epidemiological features of our patients diagnosed with SLE from the age of 80. - To delimit the average survival time and mortality, as well as the main cause of death in case of it is present. <h3>Methods</h3> A retrospective cohort of 31 patients diagnosed with SLE with an age of onset older than 80 years and followed up at the Hospital de León between 1997-2022. All fulfill the 1992 ACR and 2012 SLICC classification criteria. <h3>Results</h3> The patients were mostly women, with a female/male ratio of 2.1, and a mean age at diagnosis of 84.32 ± 2.79 years. The most prevalent clinical manifestations were arthritis and inflammatory arthralgia (48.4%) and dermatological involvement (45.1%), such as acute cutaneous lupus (35.7%), discoid (7.1%) and other reactions of unspecified photosensitivity (57.1%). Leuko-lymphopenia (45.1%) and thrombocytopenia (29.3%) were also relevant. On the other hand, the cases of alopecia (3.2%), hemolytic anemia (6.45%), interstitial lung disease (ILD) with a usual interstitial pneumonia (UIP) pattern (3.2%), sensory polyneuropathy (3.2%) and chorea (3.2%). Oral ulcers were present in 12.9% of patients, as were cases of renal involvement (1 with microscopic hematuria, 1 with proteinuria &gt; 0.5 mg/dL, 1 nephrotic syndrome, and 1 nephritic syndrome). Raynaud's phenomenon affected 16.1%, as well as serositis (4 patients with pleuritis and 2 with pericarditis). No one reported <i>sicca</i> syndrome or thrombotic events. Regarding immunological criteria, the most important findings were: ANA 97%, DNA 38%, Sm 10% and hypocomplementemia 29%. Antiphospholipid antibodies were present in 42%, and 6,5 % have triple positivity). The average survival time was 4.5 years, with a statistically significant difference in favor of women (7 vs 3.4 years; p-value = 0.0024). There were 11 losses to follow-up and 10 deaths (7 men). The fundamental causes of death were certified in 4 of the cases as infectious etiology, one due to heart failure and another due to global respiratory failure. In 4 cases the cause of death was unknown. <h3>Conclusion</h3> - Late-onset SLE diagnosed in people over 80 years of age is more frequent in women (2.1:1), although there is a higher proportion of men than in cases of earlier debut [1]. - The most frequent manifestations in our cohort were joint, skin, and hematological involvement. - The main cause of death was of infectious origin. - The average survival time was 4.5 years. - The male sex was associated with a worse prognosis in our patients, with higher mortality (70%) and significantly lower survival. - More research is needed to broaden our knowledge of SLE in this age group, as well as to clarify to what extent excess male mortality may be due to disease burden or is influenced by other factors (lower life expectancy, toxic habits, etc.). <h3>References</h3> [1]A. Riveros Frutos <i>et al.</i>, "Late-onset versus early-onset systemic lupus: characteristics and outcome in a national multicentre register (RELESSER)," <i>Rheumatology (Oxford).</i>, vol. 60, no. 4, pp. 1793–1803, Apr. 2021, doi: 10.1093/RHEUMATOLOGY/KEAA477. [2]I. W. Sohn, Y. B. Joo, S. Won, and S. C. Bae, "Late-onset systemic lupus erythematosus: Is it 'mild lupus'?," <i>Lupus</i>, vol. 27, no. 2, pp. 235–242, Feb. 2018, doi: 10.1177/0961203317716789. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.